Am I over-thinking, or are these just bad test questions?

[chicken1]

I'm a Freshman I student in an ADN program. I'm getting really frusterated with what I feel are some poorly written test questions. I get the idea that the test questions are supposed to mimic the NCLEX by having the 'critical thinking', judgement-based questions, but I think some of the questions that I've gotten wrong this semester have logical fallacies that make the question invalid. I want opinions from you guys: are these really bad questions, or am I just 'over-thinking' them, as my instructors tell me?

Question #1:

Your client tells you he is feeling pain in a location different from where it started. You know his type of pain is....

a. referred

b. viseral

c. radiating

d. cutaneous

I picked 'c', and was wrong. The answer given by the teacher is 'a', referred. My impression of referred pain is that pain is not felt at the site of tissue damage, but is felt in a different location....so 'referred' would be the correct answer if the question read ...'Your client tells you he is feeling pain in a location different from the site of tissue damage. But, the way the question is written, 'it' refers to pain, and it is true to say that radiating pain is pain that is felt in one location, and then is felt in a different location (as it radiates from one location to the next).

Question #2

What is the surgical classification for cataract removal?

a. major

b. urgent

c. restorative

d. cosmetic

I don't think any of these answers are correct, so the question is invalid. The instructor's answer was 'c', restorative. While cataract removal does result in restored vision, the definition for restorative surgery is that is 'restores function or appearance to traumatized or malfunctioning tissues'; cataract removal does not restore function to the damaged tissue, it removes the tissue and replaces it with an artifical lens. Therefore the classification pertaining to purpose should be 'ablative', or 'ablative and transplant'. I picked 'b', urgent, thinking it was the best answer out of those provided, even though I understand that cataract surgery is better classified as an elective surgery.

3. You are teaching a patient about ways to induce sleep. You will be sure to teach him that...

a. a cup of warm, regular tea before bed will help him sleep.

b. a glass of red wine promotes deep and REM sleep

c. as you age, the length and quality of REM and deep sleep decrease

d. physical activity prevents falling asleep

Again, I think there is not a fully correct answer. C is the only completely true statement, but I would NOT teach my client that if my purpose is to teach about ways to induce sleep because it is not fully relevant to the teaching topic and would obsure the main messages that the patient should learn. I picked 'd', figuring that although physical activity may help promote sleep if it is moderate and well bedfore bedtime, it can also prevent sleep if it is to the point of fatigue or too close to bedtime.

4. Which of the following statements, if stated by your client, would show understanding of the fecal occult test?

a. I must use a 1-2" piece of formed stool

b. I will complete the test over a three day period.

c. I will wait until my cycle starts to do the test.

d. I eat red meat on a daily basis.

The instructor gave the correct answer as 'a'. I had eliminated this choice because it is true to say "You do not have to use a 1-2" piece of formed stool for the fecal occult test, instead, you can use 15 mL of liquid stool. I picked 'b' instead, because the test can be completed over three days....like the Hemoccult test directions say to do. Instructor said it's better to do it over three consecutive stools, which may be true....but I think the question is invalid as written because of the logical error in using the word 'must' in choice 'a', rather than 'can'.

5. A nurse monitors a patient's vital signs and assesses his IV medications for 15 mintues. The nurse does not acknowledge or speak to the patient or the patient's spouse while she is in the room. Which behavior is the nurse best demonstrating?

a. discourtesy

b. unprofessionalism

(c and d were nonsense answers that I can't remember)

I picked 'b', unprofessionalism, while the instructor's correct answer is 'a', discourtesy. The book lists the 'elements of professional communication' as consisting of 'courtesy', 'use of names', 'trustworthiness', 'autonomy and responsibility', and 'assertiveness'. The instructor says discourtesy is the best answer because it it most specific. I think unprofessionalism is a better choice because the nurses behavior in this situation fails to be courteous, to use names, to build trust, and to promote patient autonomy; therefore, unprofessionalism encompasses all the failures in her communication which 'discourtesy' unneccessarily limits the boundaries of the behavior. In either case, I think this question is arbitrary and could have been made a valid question by simply asking 'Which behavior is the nurse most specifically demonstrating?'

Again, am I over-analyzing or do the questions have inherent flaws? Am I misunderstanding the material somehow? Any input is appreciated. As an 'A' is a 93, there is not much room for error on these tests....and I'm debating whether I should try to formally petition a few of these questions if I end up with a 91 or 92 in the class.....

[Wishinonastar, BSN]

But as you know, life is full of "Best" choices, often none are ideal. We as nurses make choices every day and you have to learn to sift through key facts quickly and act. That is how it works. If you spend excesive time overanalyzing you are paralyzed and ineffective. I do think it is fair, I do think it trains the mind to focus on key information. This is critical thinking.

[neuroms]

Even considering that argument--that you're training the student to make quick "best" decisions with very, very poor quality input--the first question r/t pain is not even of that type and is wrong. Nursing professors are a rare breed in their resistance to being corrected. Did anyone not find this to be the case in school? Did you have a nursing professor who welcomed and encouraged alternate considerations of problems?

[Wishinonastar, BSN]

How can you say that it is wrong? Pain in another place is referred pain- pain in a place other than the site of origin. What is wrong about it? Also, it is a question that is trying to determine the student's understanding of terminology. I see nothing wrong with this question.

Nursing school is not about dialog- students are novices, the teachers are experts. You are supposed to learn from them, not argue with them. They do occasionally make a mistake because they are human, but save the arguments for the softer subjects, wasting time arguing only serves to muddy the waters, anger your instructor and waste everyone's time. It is what it is. Her answer is the right one in her class whether you agree or not. She is the one with the degrees behind her name that give her the right to write these questions. Until you have those same letters after your name you have no right to say that she is wrong.

[FranEMTnurse, CNA, LPN, EMT-I]

How can you say that it is wrong? Pain in another place is referred pain- pain in a place other than the site of origin. What is wrong about it? Also, it is a question that is trying to determine the student's understanding of terminology. I see nothing wrong with this question.

Nursing school is not about dialog- students are novices, the teachers are experts. You are supposed to learn from them, not argue with them. They do occasionally make a mistake because they are human, but save the arguments for the softer subjects, wasting time arguing only serves to muddy the waters, anger your instructor and waste everyone's time. It is what it is. Her answer is the right one in her class whether you agree or not. She is the one with the degrees behind her name that give her the right to write these questions. Until you have those same letters after your name you have no right to say that she is wrong.

Well put. I agree with you completeely.

[neuroms]

Referred pain, by definition, is neurogenic pain at a site away from the injury, usually to visceral tissues. Radiating pain has a central point and contiguous areas of pain extending away from the primary site. You could have a radiating referred pain, but I don't think the question is sufficient to suggest that.

It's wrong. Also, I have never taken pause to question someone's reasoning just because he or she 'has more letters behind her name.' I just don't get it. What's the benefit to acting like you're never wrong, even when you know you are? Must be a teacher thing. But, I have to admit, something about it works. I think that's how nurses have been made since the beginning of time.

[jjjoy, LPN]

Your client tells you he is feeling pain in a location different from where it started. You know his type of pain is....

a. referred

b. viseral

c. radiating

d. cutaneous

How can you say that it is wrong? Pain in another place is referred pain- pain in a place other than the site of origin. What is wrong about it? Also, it is a question that is trying to determine the student's understanding of terminology. I see nothing wrong with this question.

My initial read of the question this: pain started in location A and then was later felt in location B, and this is what your client tells you.

From the 'correct' answer, though, I have to guess that the question *really* is to be read as follows: Your client tell you "I'm feeling pain in this location", you the nurse know (how do we know? the question doesn't tell us) that the injured tissue (where the pain 'started') is actually somewhere different from the location the patient currently identifies as having pain.

The wording of the question is not at all clear in it's meaning! I agree that referred pain *is* the right answer, but I don't agree that the question itself has no problems.

[HealthShepherd]

I hate to call this "over-analyzing" or "over-thinking". In other contexts, the concerns raised by the OP about some of these example questions is considered a laudable degree of analysis and critical thinking, not too much!

Nursing professors are a rare breed in their resistance to being corrected.

Both quoted for truth.

I'm sort of a perennial student - I did two bachelor's degrees before my BScN, and I'm now back in school doing more undergraduate studies (with a view to going on to grad school in a different field). Between four faculties in three institutions, I have never seen the kind of intellectual laziness and arrogance that I saw in my nursing teachers. And believe me, nobody in my humanities or science studies has ever told me that I was thinking too much or that I mustn't question authority.

The questions that the OP brought up are like a little microcosm of what's wrong with nursing school: sloppy writing in question 1, sloppy logic in question 3, and plain old stupidity in question 5. (To be fair, I thought question 2 was fine, and I don't have enough knowledge of the stool test to judge question 4).

But unfortunately, all of the people who have said that arguing will get you nowhere and you'll just have to deal with it are telling the truth too. In nursing school, it doesn't matter if you have the facts or logic on your side. Teacher knows best and you're just a student so be a good girl and stop thinking too hard and shut up.

I spent most of nursing school seething with contempt and anger (and as I'm sure you can tell, I sometimes relive those feelings sympathetically). At the time I thought I was just at a terrible school, but I found that the CRNE had the same sloppiness that I had come to know and hate, and that people from other schools had had the same experiences.

[Wishinonastar, BSN]

Believe me, a lot of thought and work goes into bringing the questions down in reading level because there are so many students who are just not up to snuff in reading ability. Maybe it seems that the questions are written at a low level- they probably are because otherwise half the students would not understand.

I think in each one of those questions there is one key fact that makes the correct answer obvious. You have to learn to look at the test questions that way. What makes this right above the other answers?

[Artistyc1]

Both quoted for truth.

I'm sort of a perennial student - I did two bachelor's degrees before my BScN, and I'm now back in school doing more undergraduate studies (with a view to going on to grad school in a different field). Between four faculties in three institutions, I have never seen the kind of intellectual laziness and arrogance that I saw in my nursing teachers. And believe me, nobody in my humanities or science studies has ever told me that I was thinking too much or that I mustn't question authority.

The questions that the OP brought up are like a little microcosm of what's wrong with nursing school: sloppy writing in question 1, sloppy logic in question 3, and plain old stupidity in question 5. (To be fair, I thought question 2 was fine, and I don't have enough knowledge of the stool test to judge question 4).

But unfortunately, all of the people who have said that arguing will get you nowhere and you'll just have to deal with it are telling the truth too. In nursing school, it doesn't matter if you have the facts or logic on your side. Teacher knows best and you're just a student so be a good girl and stop thinking too hard and shut up.

I spent most of nursing school seething with contempt and anger (and as I'm sure you can tell, I sometimes relive those feelings sympathetically). At the time I thought I was just at a terrible school, but I found that the CRNE had the same sloppiness that I had come to know and hate, and that people from other schools had had the same experiences.

It is, perhaps, best that you do plan to go on to another field. Your attitude towards ALL NURSING instructors is almost palpable in this letter. Most of us can just complete our studies, and move on- this really seems to have been an ordeal for you! What I don't get, though, is how so many students,by virtue of God knows what, always seem to believe that they know better than any mere instructor possibly could. Perhaps some of the students on this board should do some self examination of their attitudes- it may also be best that they rethink their career choices, though many people with these attitudes will do poorly in any arena, IMO.

[jjjoy, LPN]

And believe me, nobody in my humanities or science studies has ever told me that I was thinking too much....In nursing school, it doesn't matter if you have the facts or logic on your side.... stop thinking too hard and shut up

I wouldn't go so far as to say *nobody* from coursework in other disciplines (or that *all* of my nursing instructors) discouraged really digging into things, but in my experience it was all too common for nursing instructors to brush off logical, fact-based questions by dismissively saying "if don't you get why X is the best answer, then you aren't using your critical thinking skills" as opposed to figuring out where the student may have gone wrong... or if the student might in fact have a valid point.

Instructors would teach to never accept something just because someone says so. Providing rationales for everything was imperative. I've no problem with that. HOWEVER, if a student then questioned a rationale, some instructors seemed to automatically assume that the student just hadn't thought about it enough (or perhaps had over-thought it) and to answer such a question would be a waste of the instructor's time.

I spent most of nursing school seething with contempt and anger (and as I'm sure you can tell, I sometimes relive those feelings sympathetically).

I, too, was very frustrated with the instruction and testing at my reputable university nursing school. Not because I was getting bad grades, mind you. In fact, I quickly discovered that for myself intensive studying and in-depth comprehension did NOT help improve my test scores. It's not often that I had classes where 'over-studying' really could make taking the test more difficult!

So my frustration was that for all the time and effort that we as students put into school and that instructors put into teaching, it felt more like we were learning how to "keep your nose down and just do what's expected of you" as opposed to how to be independent-thinking clinicians.